Achalasia is a chronic condition that can increase the risk for developing esophageal cancer. It occurs when the valve between the esophagus and the stomach does not open properly and the esophageal pump does not push food down, allowing it to collect within the esophagus. This promotes enlarging and stretching of the organ. This rare illness occurs when the nerves that signal swallowing become damaged.
It is unclear why achalasia develops. We also don’t know why some people who have it go on to develop esophageal cancer.
Symptoms of Achalasia
The main symptom of achalasia is difficulty swallowing liquids. People with achalasia may also experience refluxlike symptoms such as heartburn, regurgitation, and pain with swallowing.
Diagnosis of Achalasia
To diagnose this condition, we use endoscopy, x-rays of the esophagus, and tests to measure pressure within the esophagus.
Treatment for Achalasia
The most effective treatment involves cutting the sphincter muscle, either surgically or endoscopically, to allow food to pass through the esophagus.
For patients who are older and frail, we might recommend endoscopic therapy, which involves expanding or stretching the sphincter or injecting botulinum toxin (Botox) into the sphincter. The drug paralyzes and relaxes the muscle, allowing you to swallow more normally. However, this benefit is often temporary.
Surgery for Achalasia
Surgery is the most effective treatment for people with achalasia. Our surgeons use a procedure called a Heller myotomy, which involves cutting the abnormally thickened muscle surrounding the esophageal valve. This approach allows liquid and food to pass normally through the esophagus and dramatically improves quality of life for many people with achalasia.
A separate operation called a fundoplication procedure, in which a surgeon tightens the valve between the esophagus and the stomach, is always performed at the same time. This is done to prevent gastroesophageal reflux disease (GERD), which is prevalent after cutting the esophageal valve.
Both procedures are performed with minimally invasive techniques.
Peroral Endoscopic Myotomy (POEM)
The thickened muscle around the esophageal valve can be cut without making any incisions in the skin. This is a new approach and there’s not yet much information about its long-term benefits, especially in regards to the incidence of GERD after this procedure.